C. Zollikofer

Mycotic aneurysm of the aorta

The radiographic and pathologic features of 13 cases of mycotic aneurysm of the aorta were reviewed retrospectively. In four cases the mycotic aneurysm was associated with bacterial endocarditis following aortic valve replacement, and in nine cases it was associated with spontaneous bacterial endocarditis. Postmortem examination revealed that the mycotic aneurysm was most frequently found in cases with bicuspid aortic valves. In all cases the chest radiograph revealed cardiomegally, usually with pulmonary vascular congestion. In the six patients in whom the diagnosis was established angiographically, the aneurysm was manifested by an irregular saccular collection of contrast medium under one of the coronary arteries. Mycotic aneurysms must be differentiated from other lesions with similar angiographic findings, such as a congenital aneurysm of the sinus of Valsalva, prolapse of an aortic cusp through a membranous ventricular septal defect, and a congenital aortic-left ventricular tunnel.

Selective coronary arteriography in children.

Anomalies and disease processes of the coronary arteries in children are uncommon. However, with the recent advances in cardiac surgical techniques, many of these lesions are amenable to surgery that requires accurate anatomic delineation by angiography. Ascending aortography is the angiographic procedure commonly used to image the coronary arterial anatomy in children. In some instances this procedure fails to show the extent or nature of the pathologic process. In some cases, selective coronary arteriography is essential for successful management. Twelve patients are presented in whom selective coronary arteriography was indicated, and its value is compared with that of nonselective angiography. Indications for selective coronary arteriography in children are given, and its complications are also discussed.

An essential view in coronary arteriography.

A significant stenosis of the left main coronary artery is associated with a significant mortality and is one of the major indications for aortocoronary bypass surgery. The diagnosis of this lesion on clinical grounds is inconsistent and should be established by angiography. All routine projections during coronary arteriography cause foreshortening of the left main coronary artery. Well-collimated anteroposterior and shallow right and left anterior oblique views show the main segment best. These views also show the proximal segments of circumflex and anterior descending branches, and should be routinely used during every coronary arteriogram.

Angiodysplasia of the right colon treated by embolization with ivalon (polyvinyl alcohol)

Angiodysplasia of the colon is being recognized with increasing frequency as a source of lower gastrointestinal bleeding in the elderly. In one patient with colonic angiodysplasia, superselective segmental embolization of the ileo-colic artery with Ivalon resulted in the cessation of bleeding without causing bowel infarction. However, because of the development of collateral branches to the angiodysplastic malformation, bleeding recurred. While colectomy remains the treatment of choice in younger patients, in high risk patients embolization with a permanent embolic material, such as Ivalon, is an attractive alternative.

Angiographic appearance of leiomyomas of the small intestine: Report of two cases

Benign and malignant smooth muscle tumors of the small intestine have each been considered as displaying distinct angiographic characteristics. However, as two cases illustrate, the angiographic features of benign and malignant smooth muscle tumors overlap, and radiographic differentiation of these tumors is not feasible. In most cases angiography can distinguish smooth muscle tumors from other vascular lesions.

Noninvasive localization of the aortic arch in infants with tracheoesophageal fistula. An experimental study

For surgical treatment of patients with tracheoesophageal fistulas the localization of the aortic arch is great practical importance. Aortography and CT scanning have been advocated as the radiographic techniques of choice. The location of the aortic arch can be diagnosed on a chest x-ray by the deviation of the trachea alone. A barium swallow is not required. The optimal radiographic technique for this purpose was investigated in phantom studies and tested in animals and newborns. It is proposed that in addition to the standard chest x-ray a high kvp film with hardened beam (1 mm copper -- 1 mm aluminum) be added in order to demonstrate the tracheal deviation. The additional x-ray exposure to the infant is negligible; and the technique is simple, reliable, and noninvasive.

Doming of the pulmonary valve after valvotomy.

Doming of the pulmonary valve is considered an important angiographic sign for valvar stenosis. But, this sign cannot be used with similar specificity following valvotomy because at the time of surgery a bicuspid valve is created. Pre- and postoperative hemodynamic data and right ventriculograms are reviewed in 22 patients with simple pulmonary valvar stenosis. There was no correlation between the transvalvar gradient and appearance of the pulmonary valve after surgery.